Tumor Thromboembolism Masquerading as Bland Pulmonary Embolism

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Catheter-based interventions provide an important alternative to medical surgical management of massive central pulmonary thromboembolism. Because this option is increasingly being used, it is important to recognize that not all pulmonary thromboemboli are bland. The authors describe two cases in which tumor masqueraded as bland thromboembolism. Identification of tumor thromboembolism may help to alter future work-ups, provide useful prognostic information for a patient, and affect future treatment options.

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Patient 1

A 61-year-old man developed a lower extremity deep venous thrombosis after a plane trip. Despite treatment with coumadin, recurrent symptoms of pulmonary embolization persisted. The patient presented with increasing dyspnea and was found to have marked right cardiac strain on echocardiography. A pulmonary CT angiogram suggested a large thrombus in the right pulmonary outflow tract, possible thrombus within vessels to the left lower lobe, and a large left pleural effusion.

An external pacing

DISCUSSION

There has been increased recognition of the importance of rapid identification and treatment of potentially life-threatening pulmonary thromboembolism (10). CT pulmonary angiography has gained acceptance in many medical institutions as a relatively quick, accurate, noninvasive modality to both localize and quantitate the extent of clot burden (12). With this increase in use of CT pulmonary angiograms, the interventional radiologist may be expected to perform directed therapeutic interventions.

Acknowledgment

We thank Robert A. Schwartz, MD, Department of Pathology, for providing the histologic slide.

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Neither of the authors has identified a potential conflict of interest.

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